Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9 |
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INCIDENCE, PERSISTENCE AND CLINICAL RELEVANCE OF IATROGENIC ATRIAL SEPTAL DEFECTS AFTER PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION | ||
D. Nelles1, V. O. Vij1, B. Al-Kassou1, M. Weber1, J. Vogelhuber1, T. Beiert1, G. Nickenig1, J. W. Schrickel1, A. Sedaghat1 | ||
1Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; | ||
Objective: The purpose of this study was to investigate the persistence rate and clinical impact of a persisting iatrogenic atrial septal defect (iASD) after interventional left atrial appendage occlusion (LAAO). Background: Interventional LAAO is an alternative to oral anticoagulation (OAC) for the prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Device placement requires puncture of the interatrial septum. Data regarding incidence and persistence of iASD after LAAO procedures and its clinical relevance is scarce. METHODS: RESULTS: After a median of 92 days (IQR 75-108 days), we identified 50 patients (50/144, 34.7%) with an iASD. Patients with persisting iASD had higher CHADS-VASc-scores (4.9±1.5 vs. 4.2±1.2, p=0.03), larger left atrial volumes (80.5±30.5ml vs. 67.1±19.7ml, p=0.01) and were more likely to have relevant mitral regurgitation (≥II) (46.0% vs. 12.3%, p=0.001). LAAO procedures took longer (50.1±24.3 vs. 41.1±17.8min, p = 0.06) and were more demanding in patients with a persisting iASD. Furthermore, larger device sizes were implanted (24.3±3.4mm vs. 22.1±2.8mm, p=0.03) in patients with a persisting iASD. Of note, the presence of an iASD had no impact on mortality, thromboembolism or RV dysfunction. Long term follow-up TEE (i.e. ≥ 12 months) of patients with an iASD was available in 80.4% after a median of 383 days (IQR 289-415 days). Spontaneous closure of an iASD was documented in 52.0% (26/50). Hereby, similar risk factors were identified for the persistence of an iASD in follow-up (i.e. mitral regurgitation, age, CHA2DS2-VASc score, LA volume, procedure time). CONCLUSIONS: |
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https://dgk.org/kongress_programme/ht2021/P448.htm |